Biceps Tendinitis

Biceps tendinitis is the irritation or inflammation of the upper biceps tendon, which is also referred to as the long head of the biceps (LBH) tendon. This robust, cord-like tissue links the biceps muscle to the bone in the shoulder socket.

Symptoms

• Pain with activity: Usually, the pain worsens during activities that require lifting the arm above your head, like reaching for high shelves, swimming, or throwing.
• Nighttime pain: Some people experience more intense pain at night, especially when they lie on the affected shoulder. This can interfere with sleep.
• Confined tenderness: Pressing on the biceps tendon at the front of the shoulder normally triggers a specific tenderness, a common sign of biceps tendinitis.
• Difficulty lifting items: Lifting light objects over the shoulder height can become difficult because of pain and weakness.
• Reduced grip strength: At times, weakness stretches to the hand, leading to diminished grip strength.

Causes

• Repetitive overhead movements: Activities like lifting, swimming, or throwing, which involve repeated overhead motions, can stress the biceps tendon, resulting in inflammation with time.
• Jobs or sports with frequent arm movements: Occupations or sports involving frequent overhead arm movements increase the likelihood of biceps tendinitis.
• Aging: The biceps tendon tends to naturally weaken with age, making it more prone to injury and inflammation.
• Wear and tear: Chronic wear and tear, especially in persons over 40 years, can contribute to the development of tendinitis.
• Shoulder impingement: When the gap between the shoulder bones constricts, the biceps tendon can get pinched, leading to irritation and inflammation.

Diagnosis

At The Joint Pain Clinic, we diagnose biceps tendinitis through:

• Physical examination: The physician will start by reviewing your symptoms as well as medical history, followed by an assessment of your shoulder. They will also check the strength, range of motion, and stability of your shoulder and conduct specific tests to evaluate the biceps tendon functionality.
• Ultrasound: This imaging method offers an in-depth view of soft tissues, including the biceps tendon.

Treatment

Our treatment options for biceps tendinitis depend on the symptoms and severity of the condition. Often, multiple approaches are combined to achieve the best results. These include:

• Conservative management

This involves resting, modifying activity, and using anti-inflammatory drugs.

• Physiotherapy

A progressive program of stretching and strengthening exercises to improve shoulder movement dynamics. It can also be done to balance the shoulder’s stabilizing muscles. Moreover, exercises to strengthen the rotator cuff tendons help prevent abnormal strain on the LHB tendon.

• Injection treatments

A local anesthetic and cortisol injection can be administered into the sheath if inflammation surrounds the biceps tendon. When combined with physical therapy, the injection’s anti-inflammatory properties can help patients recover by reducing pain and swelling.

• Arthroscopic debridement

A tear in the long head of the biceps tendon structure can frequently be seen during shoulder arthroscopy. Debriding the tear back to a smooth surface so that shoulder movement doesn’t worsen the torn surface can provide symptomatic relief, provided the tear is not too serious. A biceps tenodesis or tenotomy would need to be considered if the tear is too big. This can be done through two or three tiny incisions as a “key-hole” surgery.

• Biceps tenodesis

The long head of the biceps is separated from the shoulder during biceps tenodesis and reconnected to the humerus immediately outside the shoulder joint. As a result, the LHB is removed from the joint where it is causing irritation. Since this surgery is typically carried out as an arthroscopic operation, two or three tiny incisions, each around 1 cm long, would be required. A rotator cuff repair may also be necessary if there is a corresponding tear in the rotator cuff tendon. The location and extent of the rotator cuff tear would determine the type of procedure.

• Biceps tenotomy

The LHB may be severed (tenotomized) if the extent of tendon degeneration or the tear size is too large to retain it. As a result, the tendon is free to recede down the arm to get out of danger. This typically provides good symptom relief and is a suitable treatment when a significant, irreparable rotator cuff tear is linked to biceps pain. A “Popeye sign” could develop if the tendon retracts down the arm because it is not attached back to the humerus.

Managing Biceps Tendinitis

The first line of managing biceps tendinitis is often with non-invasive approaches, which work well for many.

These approaches include:

• Rest: Refrain from activities that trigger pain to allow the tendon to heal.
• Ice therapy: Applying cold packs several times per day for at least 20 minutes helps ease swelling. Do not directly apply ice on the skin.
• Steroid injections: Strong anti-inflammatory drugs, including steroids such as cortisone, can be injected into the tendon. This helps alleviate discomfort.

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